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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209140
Report Date: 04/19/2021
Date Signed: 04/22/2021 11:11:15 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:GAREM ASSISTED LIVINGFACILITY NUMBER:
107209140
ADMINISTRATOR:HOPPER, JOCELYN BAREFACILITY TYPE:
740
ADDRESS:4266 N 9TH STREETTELEPHONE:
(559) 940-9708
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:6CENSUS: 0DATE:
04/19/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Administrator Jocelyn HopperTIME COMPLETED:
04:00 PM
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On 4/19/2021 at approximately 2:07 PM Licensing Program Analyst's LPA Shawna Doucette contacted the facility via telephone to commence a pre-licensing visit via telephone Face Time due to COVID-19 and pre-cautionary measures. LPA identified themselves and discussed the purpose of the call with Administrator JoyceLyn Hopper.

LPA toured facility with Administrator JoyceLyn Hopper. Common rooms have adequate furnishings and lighting. All of the resident bedrooms have all the required furnishings and adequate lighting. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Water temperature runs at 116 F in bathroom. Kitchen observed to have dishes, plates, utensils. Cleaning supplies are stored in a locking cabinet in the garage and under kitchen sink. Medications and knives are locked in cabinet. First aid kit contains all the required items. A fire extinguisher is present and has a service date of 9/23/20. Smoke detectors and carbon monoxide were operating properly. Facility has Covid 19 signs and hand washing signs posted. Facility has Covid pre cautionaries in place at the entrance of the facility. Facility needs N95 masks, gowns and face shields. Facility has surgical masks, gloves, hand sanitizer and thermometer.

Outside of the facility toured. Exits open free of obstruction. No outside hazards or bodies of water were observed. LPA observed outdoor seating for residents.

All required postings are posted. Facility phone number will be (559) 797-9284 .

Component III was conducted during pre-licensing visit with Applicants.

LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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